Antiphospholipid syndrome: Laboratory testing and diagnostic strategies

Abstract

The antiphospholipid syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and/or pregnancy loss in the presence of persistent laboratory evidence for antiphospholipid antibodies. Diagnostic tests for the detection of antiphospholipid antibodies include laboratory assays that detect anticardiolipin antibodies, lupus anticoagulants, and anti‐β2‐glycoprotein I antibodies. These assays have their origins beginning >60 years ago, with the identification of the biologic false positive test for syphilis, the observation of “circulating anticoagulants” in certain patients with systemic lupus erythematosus, the identification of cardiolipin as a key component in the serologic test for syphilis, and the recognition and characterization of a “cofactor” for antibody binding to phospholipids. Although these assays have been used clinically for many years, there are still problems with the accurate diagnosis of patients with this syndrome. For example, lupus anticoagulant testing can be difficult to interpret in patients receiving anticoagulant therapy, but most patients with a thromboembolic event will already be anticoagulated before the decision to perform the tests has been made. In addition to understanding limitations of the assays, clinicians also need to be aware of which patients should be tested and not obtain testing on patients unlikely to have APS. New tests and diagnostic strategies are in various stages of development and should help improve our ability to accurately diagnose this important clinical disorder. Am. J. Hematol., 2012. © 2012 Wiley Periodicals, Inc.

Management of Women with Recurrent Pregnancy Losses and Antiphospholipid Antibody Syndrome

“…As a consequence, several new tests have been currently explored as potential alternatives to improve the sensitivity and specificity of diagnostic laboratory testing for aPL. 87 Recent studies have investigated the clinical significance of autoantibodies specific for an epitope glycine40-arginine43 (G40-R43) in domain I of b 2 GPI in APS. A study from de Laat et al 88 found that patients with antibodies against epitope G40-R43 had an 18.9-fold increased risk of thrombosis compared with patients with antibodies to other specificities.…”

Cardiovascular Management in Pregnancy

“…107 Testing is ideally done when the patient is stable and should be repeated in 12 weeks to confirm results. 108 In our practice, we often perform antiphospholipid screening during pregnancy after taking a detailed obstetric history and initiate therapy based on results. We repeat testing postpartum after completion of anticoagulation therapy.…”

Therapie des akuten arteriellen Gefäßverschlusses der oberen Extremität beim sekundären Antiphospholipidsyndrom

“…Dabei spielen Autoantikör-per, Lupusantikoagulans und Antikörper gegen Cardiolipin und β-2-Glykoprotein I (jeweils IgM und IgG) eine wichtige Rolle [8].…”